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Malocclusion Index of Orthodontic Treatment needed ( IOTN)

Malocclusion Dental Health Component


• Def : Variation from ideal occlusion which - Look MOCDO ( Missing, Overjet,
has dental health and or psychological Crossbite, Displacement, Overbite)
implications for the individual. - Grade 1: no need
- Grade 2: little need
- Grade 3: moderate need
- Grade 4: great need
- Grade 5: very great need

Aesthetic Component
Psychosocial impact if malocclusion
- Score 1,2 : none
- Score 3,4 : slight
- Score 5,6, 7 : moderate
Aetiology - Score 8,9,10 : definite
1. Inherited
2. Environmental: habits, caries, trauma
3. Combination
4. Evolutionary trends: decrese in size and
no of teeth, size of jaw
5. Disease of civilisation: reduced use of
masticatory muscles, less proximal wear of
denition
6. Genetic Melting pot: Hawaiian melting
pot, Polynesian, European and oriental
contributors

Specific Causes of Maloclusion:


1. Disturbances in Embryologic
Development : teratogens
2. Skeletal Growth Disturbances:
intrauterine molding
3. Muscle Dysfunction: cerebral palsy,
torticollis
4. Acromegaly and Hemimandibular
hypertrophy
5. Disturbances of dental development:
- Congenitally missing teeth
- Interference with eruption
- Ectopic eruption
- Early loss of deciduous teeth
- Trauma

Angle’s Classification
- Based on first molar

British Standards Institute’s Classifications


- Based on incisor relation
1. Class 1: Normal
2. Class2 division 1: Overjet
3. Class 2 division 2 : Crossbite
4. Class 3: negatuve overbite
Andrew’s 6 keys of Occlusion in Permanent teeth

Case 1:
Permanent Denitition
Incisor: Class 2 division 2
Crowding
Snigle tooth crossbite ( 1st premolar)

Features of Deiduous Denitition


1. Arch ovoid CASE 2:
2. Deep bite present initially present
Mixed denitition
3. Developmental spaces
Incisor: class 2 division 2 – overjet
4. Shallow intercuspal contact
5. Straight/ vertical inclination of incisor Angle cant determined
6. Flat curve of spplee Etopic eruption
7. Minimal overjet Single tooth crossbite

Need for Orthodontic Treatment


- Psychology

- Dental Health :
1. Caries
2. Periodontal Health
3. Trauma to anteriors
4. Mastication CASE 3:
5. Speech
Mixed Denitition
6. Impacted teeth
UNILATERAL CROSSBITE
Mandibular primary 1st molar Mesial to upper one
Risk of Othodontic Treatment
1. Demineralisation:
Prevention: Dietary Advice, improve oral
Hygiene, increase availability of fluoride
2. Periodontal Attachent loss:
Prevention: improve oral hygiene, avoid
moving teeth out of alveolar bone
3. Root Resorption:
Avoid treatment in patient with reabsorbed,
blunted or pipette-shaped roots Case 4 :
4. Loss of vitality: Normal
Prevention: if history trauma to incisor,
counsel them
5. Relapse:
Prevention: Avoidance of unstable tooth
positions at end of treatment, retention
Case 5 :
Class 3 angle
Bsi class 3

Case 6:
Mixed Denitition
Openbite
Angle class 1
Most lilkely will become overbite